Celebrating our profession

by Linda Groah, RN, MSN, CNOR, FAAN

Perioperative nursing has come a long way. Just a generation ago, our role was confined to caring for the patient while in the operating room only. We did not have any knowledge of the patient prior to their arrival in the OR. Today, we are an integral and active partner with the surgical team at every step of the process; it’s an evolution that we are proud of. Our principal roles are those of a patient advocate and champion of patient safety.

Changing Climate

As every healthcare professional knows, the healthcare climate is changing rapidly and the impact of that change affects every one of us. In some ways, the future is of concern. We are projecting a severe nursing shortage, and currently have a decrease in nurses educated specifically to work in the OR due to curriculum revisions that have removed the OR rotation from the clinical rotations. AORN is addressing those issues through an online course, Periop 101, that hospitals can administer to their nursing staff to help educate and train them on how to be effective perioperative nurses.

In other ways, the outlook is extremely positive. These changes provide us with a greater awareness of the cost of care and the desire to research and implement evidence-based practices that can more effectively—and safely—treat patients, while helping to drive down the costs of healthcare. We are also learning the difficult but important lesson of collaborating with teams inside and outside of the OR.

Earlier in my career as COO and CNO head of nursing at a medical center in San Francisco, we made it a strategic imperative that the nurses collaborate closely with an infection preventionist to assess why we had an increase in sternal wound infections. The infection preventionist and the OR manager worked together to develop an audit tool that was used to monitor the surgical procedures. Following the observations, the infection preventionist made a list of recommendations for changes in practice which were presented to a joint meeting of the cardiac surgeons and the perioperative nurses. A plan was developed for implementation and within six months we noted a significant decrease in the number of sternal wound infections.

While our industry may be in a state of change right now, perioperative nursing is a growing and evolving career that is headed in an exciting direction. Our role inside and out of the OR is ever-expanding and includes greater collaboration with the surgical team, infection prevention departments and patients. We are starting to see more perioperative nurses as surgical case managers, nurse practitioners, first assisting, and serving as liaisons with families of surgery patients. Because our hospitals treat a diverse population, we also must fill a role of providing culturally competent care for patients of different ethnicities. Further, the increased adoption of electronic medical records, with standardized nomenclature, will give us greater access to information that can help us create cost-effective solutions that will benefit our institutions, staff and most importantly, patients. After all, patients are what drive us to promote safe care with optimal outcomes at each encounter.

Promoting Hand Hygiene Compliance

When it comes to patient safety and the prevention of hospital-acquired infections, perioperative nurses are often at the vanguard, looking for new ways to improve practices and protect patients from surgical site infections. That’s why it’s no surprise that we continue to push ourselves, our organizations and our patients to practice good hand hygiene and promote compliance with hand hygiene protocols. We educate patients on how to prepare their skin pre-operatively, and care for their dressing, post-operatively. While in the OR, we make sure that all medical personnel adhere to proper protocols. We even encourage our patients to be vigilant about hand hygiene when healthcare providers and visitors alike enter their room.

Yet, despite our best efforts, basic hand hygiene still remains a challenge. Long recognized as the single most important factor in preventing healthcare-associated infections (HAI), compliance with recommended hand washing procedures among healthcare workers averages only about 40 percent.¹ Many institutions have been hitting this issue head on with everything from educational sessions to the use of blacklight to detect biological material on hands. There is no greater reminder about the importance of proper hand hygiene than to know that it is the easy way to protect patients from hospital-acquired infections.

Recently, AORN updated its “Recommended Practices for Hand Hygiene in the Perioperative Setting” ² to provide guidance for hand hygiene for surgical and other invasive procedures. The seven recommendations cover all aspects of hand hygiene from the wearing of jewelry to standardized protocol for proper hand sanitizing at every point of contact with a patient and the use of scrub solutions that meet the FDA standards of persistent and cumulative activity, including the use of alcohol-based antiseptic hand rub. The full report can be found at www.aorn.org. 

Another initiative that we recently undertook was partnering with 3M Healthcare on a program called “It’s in Your Hands,” which not only promotes the hand hygiene best practices outlined in the Recommended Practices, but also recognizes and celebrates the contribution that perioperative nurses make every day. This collaboration consists of two major initiatives. The first is a YouTube video contest, in which perioperative nurses and nurse teams from around the country submitted videos depicting how they follow the Recommended Practices. The second is the “Hand Hygiene Champions” award, intended to recognize individuals and teams who are a model in good hand hygiene practices and help their organizations creatively adhere to the Recommended Practices.

Both initiatives will be on full display at this year’s Congress (March 13-18) where we will be announcing the winner of the video contest. Additionally, participants will have the opportunity to nominate a colleague, a team, or themselves, for the “Hand Hygiene Champions” award; winners will be officially announced during National Nurses Week in May.

AORN Congress is really where practice and passion come together. For more than 55 years, the AORN annual Congress has served as an opportunity for learning, sharing best practices and most importantly, celebrating our profession. This year’s Congress will be no exception. We are excited to welcome everyone to our home town and create a week that will both educate and inspire. We look forward to seeing you there!

References

1. http://multimedia.3m.com/mws/mediawebserver?66666UuZjcFSLXTt4XM65xf2EVuQEcuZgVs6EVs6E666666–
2. Association for periOperative Registered Nurses (AORN). Recommended Practices for Hand Hygiene in the Perioperative Setting. 2009.

Linda Groah, RN, MSN, CNOR, FAAN is executive director and CEO of the Association for periOperative Registered Nurses (AORN).